Breast Cancer

Diagnosis

To diagnose what type of breast problem you have there are several options:

Core Needle Breast Biopsy - Usually done in Radiology with mammographic/ultrasound guidance.

In a core needle biopsy, the physician makes a small skin incision through which a needle is inserted into the lesion to obtain sample tissue. The hollow spring-loaded device is "fired" repeatedly into the abnormality to collect a sufficient amount of breast tissue for analysis. Usually, 4 to 6 samples are taken (4 to 6 insertions). This biopsy procedure is performed in an outpatient hospital setting.

Mammotome Breast Biopsy - A small probe is inserted into the breast through an incision about the size of a match head. Vacuum is used to gently draw, cut and collect tissue into the probe's hollow chamber. This biopsy technique enables several samples to be acquired resulting in a highly accurate diagnosis. Since multiple tissue samples are obtained without removing and reinserting the problem, there is less internal scarring, which minimizes interference with future monitoring and diagnosis of breast abnormalities. This is usually done in an office setting.

Incisional Biopsy - An incision is made and a small portion of mass area is taken out (schematic picture - circle with piece of pie taken out)

Excisional Biopsy - The entire mass area is taken out (schematic picture - Box w/circle inside with arrow showing entire circle coming out)

Stereotactic Guided Excisional Breast Biopsy - A needle is inserted under mammogram or ultrasound guidance into the mass or problem area, an incision is made and the surgeon is guided to the area via the needle.
Depending upon the results of biopsy you may need routine follow-up, continued close follow up, further treatment.

Breast Cancer Surgical Treatment Options
A lumpectomy is a surgical procedure to remove abnormal and/or cancerous tissue from the breast. Surrounding healthy tissue also is removed to increase the odds of removing all cancer cells. The lymph nodes under the arm also are examined in either a sentinel lymph node biopsy or an axillary lymph node dissection.

Because lumpectomies leave the breast mostly intact, they are often the preferred form of surgery when treating breast cancer. However, they are usually effective only in the early stages of breast cancer, and almost always are followed by several weeks of radiation therapy. In addition, some circumstances may preclude women from being good candidates for lumpectomies.

A mastectomy is a surgical procedure to remove part or all of one or both breasts. It is usually performed to treat or prevent breast cancer. There are several different types of mastectomies including:

Partial mastectomy. Removal of some of the breast tissue
surrounding the tumor and the lining of the chest muscles beneath it. In some cases, lymph nodes under the arm may also be removed.

Simple mastectomy. Removal of all of the breast tissue, including the lobules, ducts, fatty tissue and a strip of skin with the nipple and areola.

Modified radical mastectomy. Removal of the entire breast and some lymph nodes from under the arm.

A mastectomy can cure breast cancer and dramatically reduce the likelihood of its return, but there is a chance for the cancer to recur. Breast tissue is widely distributed on the chest wall and can sometimes be found in the armpit and in areas stretching from above the collarbone down to the abdomen. Some of these areas are not within the scope of a mastectomy, and other forms of treatment may be necessary to help ensure that all cancer is treated (e.g. chemotherapy).  

Mastectomies can be emotionally challenging for women faced with the loss of one or both breasts. For this reason, many women choose to undergo a breast reconstruction that creates an artificial breast closely approximating a natural breast. For more information on these procedures, see Breast Reconstruction.

Breast reconstruction can be immediate (at the time of mastectomy) or it can be done later after the patient has completed treatment.

When reconstruction is necessary, a woman can decide among the various forms of reconstruction, which include saline implants, silicone implants or an autologous flap reconstruction (using skin, tissue and possibly muscle from the patient's abdomen, back or buttocks).

Each option carries with it its own benefits and risks. A woman should discuss the options carefully with a qualified physician - usually a plastic surgeon - as not every breast cancer patient is a candidate for every type of reconstructive surgery. However, today there are a wide variety of options available to women who want to create a new and natural-appearing breast, offering the breast cancer patient both physical and emotional healing.

The Stages of Breast Cancer

A breast is made up of lobules, ducts, fatty tissue, blood vessels. The lobules are glands that make milk; the ducts are tubes that link the lobules to the nipple. The fatty tissue surrounds the lobules and ducts. Lymph vessels carry lymph to lymph nodes in the underarm, above the collarbone, and in the chest. There are also lymph nodes throughout the body.

Your doctor will look at a number of factors, including the size of the tumor, the role of lymph nodes, and how far the cancer has spread, to determine the stage of your breast cancer. There are early stages (0, I, and II) of breast cancer and advanced stages (III and IV) of breast cancer.

Early Stages of Breast Cancer

Stage 0
Cancer cells are present in either the lining of a lobule or a duct, but they have not spread to the surrounding fatty tissue.

Stage I
Cancer has spread from the lobules or ducts to nearby tissue in the breast, and tumor is 2 cm (3/4 inches) or less in diameter; the lymph nodes are not involved.

Stage II
Cancer has spread from the lobules or ducts to nearby tissue in the breast, and tumor is about 2 to 5 cm (3/4 to 2 inches) in diameter, sometimes the lymph nodes may be involved.

Advanced Stages of Breast Cancer

Stage III
May include locally advanced cancer; tumor may be larger than 5 cm (2 inches) across, and cancer may or may not have spread to lymph nodes or other tissues near the breast.

Stage IV
Known as metastatic; cancer has spread from the breast and lymph nodes under the arm to other parts of the body, such as bone, liver, lung, or brain.

The recurrence of breast cancer-the return of cancer after remission of the disease-can occur at the site of the first tumor, in the lymph nodes adjacent to the cancerous breast, or in other parts of your body.